A contraindication for topical corticosteroid usage in a male patient with atopic dermatitis (eczema) is:
A. Parasite infection.
B. Viral infection.
C. Bacterial infection.
D. Spirochete infection.
Correct Answer: B. Viral infection.
Topical agents produce a localized, rather than systemic effect. When treating atopic dermatitis with a steroidal preparation, the site is vulnerable to invasion by organisms. Viruses, such as herpes simplex or varicella-zoster, present a risk of disseminated infection. Educate the patient using topical corticosteroids to avoid crowds or people known to have infections and to report even minor signs of an infection. Topical corticosteroid usage results in little danger of concurrent infection with these agents.
Option A: Betamethasone dipropionate and diflorasone diacetate have an increased ability to suppress adrenal function. Around 14 g/week of clobetasol propionate ointment may induce suppression in children, while 49 g/week of betamethasone dipropionate reduces plasma cortisol levels. Temporary reversible suppression is seen with 49 g of superpotent TS used for 2 weeks.
Option C: Topical steroids induce resorption of mucopolysaccharide ground substance in the dermis. Repeated use in the same area causes epidermal thinning and changes in the connective tissue of the dermis leading to lax, transparent, wrinkled, and shiny skin along with striae, fragility, hyperpigmentation, and prominence of underlying veins. The loss of connective tissue support for dermal vasculature results in erythema, telangiectasia, and purpura.
Option D: Mucocutaneous infections (tinea versicolor, onychomycosis due to Trichophyton and Candida species, dermatophytosis) are common during treatment with TS, occurring early in the therapy. The incidence varies between 16% and 43%. When dermatophyte infections are treated with TS, the symptoms and signs improve transiently, giving rise to tinea incognito. TS suppresses the normal cutaneous immune response to dermatophytes leading to the enchantment of fungal infections. An immune mediated phenomenon called “tinea pseudoimbricata” is a particular type of tinea incognito which has been described by one of the authors.